According to retrospective data, racial disparities among patients being screened for lung cancer have decreased.
In 2021, the US Preventive Services Task Force (USPSTF) altered its age and smoking status and found reduced racial disparity in qualifying patients for lung cancer screening in a recent analysis. This retrospective analysis assessed whether patients enrolled in an epidemiology study (Inflammation, Health, Ancestry, and Lung Epidemiology [PMC5010488])would qualify for screening using the 2021 USPSTF criteria, the 2013 USPSTF criteria, and the 2012 Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (PLCOm2012) criteria.1,2
The 2021 USPSTF guidelines expanded its age range and altered its smoking status to include adults between ages 50 and 80 years with a 20-pack year smoking history who are currently smoking or who have quit smoking within the past 15 years. The previous criteria, the 2013 USPSTF, included those between 55 and 80 years with a 30-pack year history.
All patients were between 21 and 89 years of age. The study only included patients with a history of smoking. Patients, with or without lung cancer, who had never smoked were excluded in the analysis.
Using the 2021 USPTSF lung cancer screening criteria, 65% (n = 590) of the patients with lung cancer were eligible for screening. The 2013 USPSTF criteria identified 49% (n = 445) of patients with lung cancer were eligible for screening, and the PLCOm2012 criteria found that 68% (n = 619) patients were eligible. The 2021 USPSTF and the PLCOm2012 both presented less racial disparity in their patients who qualified for lung cancer screening than the 2013 USPSTF. The 2021 USPSTF criteria found 408 of the 625 (65%) White patients and 182 of 287 (63%) African American patients were eligible, and the PLCOm2012 criteria found 427 of 625 (68%) White patients and 192 of 287 (67%) African American patients were eligible. The 2013 USPSTF, however, did show racial disparity with significantly more White patients than African American patients with lung cancer eligible for screening (324 of 625 [52%] vs 121 of 287 [42%], respectively).
Using the 3 guidelines, investigators assessed 912 patients with lung cancer and 1457 patients who did not have lung cancer, the control group. These patients were enrolled at a study in the Detroit metropolitan area between May 15, 2012, and March 31, 2018. Analysis of the data was conducted from August 31, 2020, to April 13, 2021. End points were sensitivity and specificity. Sensitivity was defined as the percentage of patients with lung cancer who qualified for screening, and specificity was defined as the percentage of patients in the control group who did not qualify for screening.
Concerning the control group, the 2021 USPSTF excluded 709 control participants (49%), the 2013 USPSTF excluded 950 (65%), and PLCOm2012 criteria excluded 843 (58%).Similar to the number of patients with lung cancer who were deemed eligible, the 2021 USPSTF and PLCOm2012 criteria revealed fewer differences in race compared to the 2013 USPSTF when evaluating patients in the control group. The 2021 USPSTF ruled out 401 of 838 (61%) White patients and 308 of 619 (50%) African American patients, and the PLCOm2012 eliminated 475 of 838 (57%) White and 368 of 619 (60%) African American patients from screening eligibility. And again, the 2013 USPSTF criteria favored White control patients, excluding 514 of 838 (61%) White patients vs 436 of 619 (70%) African American patients.
The changes made to the 2021 USPSTF improved upon earlier screening criteria for lung cancer and reduced racial disparity in this study.
1. Pu CY, Lusk CM, Neslund-Dudas C, Gadgeel S, Soubani AO, Schwartz AG. Comparison between the 2021 USPSTF lung cancer screening criteria and other lung cancer screening criteria for racial disparity in eligibility. Published online January 13, 2022. JAMA Oncol. 2022;e216720. doi:10.1001/jamaoncol.2021.6720
2. Schwartz AG, Lusk CM, Wenzlaff AS, et al. Risk of lung cancer associated with copd phenotype based on quantitative image analysis. Cancer Epidemiol Biomarkers Prev. 2016;25(9):1341-1347. doi:10.1158/1055-9965.EPI-16-0176